Microsoft word - renal up date for renal patients.doc
Evolving guidelines for the management of patients with Influenza A (H1N1) 23rd July 2009 The government has announced important changes to the way it is managing the swine flu pandemic in the UK. Cases of swine flu will now be confirmed clinically rather than through lab testing. The way in which the antiviral medicines OSELTAMIVIR (TAMIFLU) and ZANAMIVIR (RELENZA) are used and distributed has also changed: In England, symptomatic individuals will be able to contact the Pandemic Flu Information Line: 0800 1 513 513 to hear about flu and its symptoms. If their symptoms are suggestive of flu they should use the telephone or web-based assessment using the National Pandemic Flu Service, to identify whether they need antiviral drugs. If they do, they will be given a reference number entitling their flu friend to pick up the medication at a local collection point. Currently this service does not cover Scotland, Wales or Northern Ireland as the demand is not as great. The current arrangements in place in the different home countries are summarized at http://www.direct.gov.uk/en/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_17 8842.htm Patients in Scotland can phone NHS 24: 08454 24 24 24, NHS Direct Wales: 0845 46 47 Northern Ireland Swine Flu Helpline: 0800 0514 142 (Monday to Friday, 9am to 5pm)
Patients in those countries currently will continue to receive antiviral drugs, when indicated, from their GPs. When accessing the National Pandemic Flu Service, patients will be asked whether they have chronic kidney disease and whether they attend a specialist renal or kidney clinic for the care of renal or kidney failure? If they answer YES to this and are older than 5 years of age they will be authorised ZANAMIVIR (RELENZA). Those under 5 will be authorised OSELTAMIVIR (TAMIFLU) and advised to take the first dose and then to contact their renal specialist for advice on second dose. Patients under the care of a kidney specialist will be advised to contact their GP or renal unit for further advice if they develop worsening symptoms. Any patient on dialysis, will be asked to inform their renal team immediately, that they have flu as the local renal unit may need to make appropriate isolation arrangements. The usual way for a patient to obtain antiviral drugs in England will be to have their 'flu friend' collect their antiviral medicine from the local collection point on the advice of the telephone helpline (in Scotland, Wales and Northern Ireland their 'flu friend' will need to collect a prescription from the GP). These arrangements will also apply to any outpatients on renal replacement who should NOT be expected to obtain supplies of antiviral agents from the dialysis unit. Patients who have dialysis should take their medicine with them to the session, so that they can take the dose after the dialysis session.
However, should any patient be hospitalised the usual arrangements for prescribing drugs including antiviral drugs within hospitals apply. It is recognised that a number of individuals may be at high risk from H1N1. This includes people with long-term conditions (particularly those with underlying lung conditions), those over 65, children under five and pregnant women. Currently pending further information it would be reasonable to consider the following groups of our patients as being at "high risk" and clinicians may wish to advice their patients accordingly.
¾ chronic kidney disease stages 1-3 if on immunosuppression, ¾ chronic kidney disease stages 4 & 5, ¾ nephrotic syndrome and ¾ renal transplant patients.
ENT ASSOCIATES Michael J. Brown, M.D. Jeffrey C. Nau, M.D INSTRUCTIONS AND INFORMATION FOR SINUS SURGERY ABSOLUTELY, DO NOT TAKE ASPIRIN, MOTRIN, IBUPROFEN, ADVIL, EXCEDRIN, ALEVE NAPROXEN, NUPRIN, ALKA-SELZER, OR SIMILAR NON- TYLENOL PAIN RELIEVERS FOR 2 WEEKS BEFORE AND AFTER SURGERY UNLESS APPROVED BY YOUR SURGEON. THESE INCREASE THE RISK OF BLEEDING! DO NOT TAKE OVER-THE-COUNTER
MIKRA’EY KODESH " Holy Convocations " Author: Torah Teacher Ariel ben-Lyman HaNaviy (Note: all quotations are taken from the Complete Jewish Bible, translation by David H. Stern, Jewish New Testament Publications, Inc., unless otherwise noted) *Updated: December 26, 2005 Minor Feasts PURIM "The Festival of Lots" "Study to shew thyself approved